Provider Demographics
NPI:1528026416
Name:MAGNOLIA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL MEDICAL CENTER
Other - Org Name:MAGNOLIA EMERGENCY PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-235-3212
Mailing Address - Street 1:101 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-0629
Mailing Address - Country:US
Mailing Address - Phone:870-235-3452
Mailing Address - Fax:870-235-3667
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-0629
Practice Address - Country:US
Practice Address - Phone:870-235-3452
Practice Address - Fax:870-235-3667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-02
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101605002Medicaid
AR57952Medicare ID - Type Unspecified